Alcoholic abstinence in elderly subjects with misuse of alcohol.

Alcohol use disorder does not disappear with aging, neither the associated induced-suffering. While the prevalence of alcohol use disorder still remains around 10% in the subjects over 65 year old age, and daily encountered by hospital or nursing-home caregivers. Alcohol misuse is often overlooked in elderly people, which then obtain lesser care than younger adults although the care prognosis remains as good as or better than before the age of 65, alcoholic abstinence gets always a place among care offers to elders suffering of alcohol use disorders and dependence. However abstinence is a complex notion gathering various representations or meanings, and induces necessary psychological changes. Alcoholic abstinence seems thus to be feared by families or caregivers, because of lack of knowledge about the addictive dimension of the disorder. On behalf of ultimate freedom, and allowing a last pleasure, alcohol use disorders and its associated suffering can be neglected because abstinence is considered as aggressive and harmful. However, modalities of reduction of alcohol consumption as well as access control or regulated supply of alcoholic beverages, keep having a place in graduate care offers. Beyond the choice of decreasing or suppress drinking alcohol beverages, which only are terms or conditions of improvement, the main point remains the improvement of well-fare, quality of life and elders' health.

[The place of alcohol in hospital meals]. / La place de l'alcool dans les repas à l'hôpital.

Wine and other types of alcohol are generally seen as an important part of French tradition. A study was carried out at Mâcon hospital to reflect on the place of alcohol in meals served on short stay medical-surgical wards. The results show that the consumption of wine, which was already modest ten years ago, had almost disappeared by 2010, without the offer having been restricted. It would seem that it is possible to be hospitalised for a few days without drinking wine.

[Vocally disruptive behaviors]. / Les comportements vocaux perturbateurs.

Vocally disruptive behaviors are not uncommon in the elderly, especially in dementia and institutionalization context. Although they do not constitute the most frequent of the behavioral symptoms of dementia, they are one of the most disturbing and therefore a challenge for nursing home staff. They can result in serious consequences for the patient itself as well as for caregivers, nursing staff and other residents. An increasing number of studies have been performed on the vocally disruptive behaviors during the last years, but most of studies were devoted to individual cases or very small series. Nevertheless, a review of the literature may provide some suggestions for their management.

[Acute alcoholic intoxication in subjects over 75 years of age: a clinical situation far to be uncommon]. / Intoxication éthylique aiguë après 75 ans : une situation clinique loin de l'anecdote à l'hôpital.

Acute ethylic intoxication (AEI) or alcoholic drunkenness is not only a youth-specific disorder. It also occurs at advanced ages of life. Diagnosis is not easy, at times made in excess, but more often underestimated, then leading to the negligence of a risk situation and suffering. AEI represents about 3% of all hospitalizations. In 2005, 973 alcohol tests taken at the hospital of Mâcon (France) were positive. The rates ranged from 0.10 g/L to 6.26 g/L (m = 2.06 +/- 1,18). 41 subjects were aged over 75 (5%). The alcohol rates found were lower after 75 years (1.34 +/- 1.1 g/L) than before 75 years (2.11 +/- 2,1; p<0,001). Subjects were referred to the Emergency unit for a fall in 61% of the cases, and dizziness in 34%. Among the aged subjects, 30% received external care and 70% were hospitalized. According to the DSM-IV, misuse of alcohol was found in 87% of subjects (abuse in 67%, addiction in 20%) and temperance in 13%. Drinking alcohol is not a pathology in itself. However, if it causes suffering or has negative consequences on health or lifestyle, care is required. Aging doesn't change anything to this reality. AEI, in truth, requires even more specific care and attention, in the elders.

[Bipolar disorders and dementia: fortuitous association or filiation? A case-report and review of the literature]. / Troubles bipolaires et démence: association fortuite ou filiation?

The prevalence of bipolar disorders is about 4% of the population. Among the patients the emergence of cognitive disorders has been identified. These disorders can sometimes result in authentic dementia-like syndromes. The neuropsychological characteristics of the cognitive impairment include disorders of the steady attention, executive functions, memory and language. This group of cognitive disorders leads to a subcorticofrontal syndrome. Different neuroanatomical bases have been suggested. The most common etiopathogenic hypothesis retains a cumulative neurological toxicity of the thymic episodes (depression or mania). The role of psychoactive treatments must be taken into account. The secondary cognitive effects of psychoactive drugs usually used in bipolar disorder (lithium, antiepileptics, antidepressants, antipsychotics or tranquillizers) are similar to the cognitive impairment associated with the disease. Differentiation between cognitive disorders related to the pathology and those related to its treatment is difficult. The optimal use of the therapeutic drug classes, preferring antipsychotics of second generation and avoiding products with anticholinergic effect, is essential. There is no specific pharmacological treatment for this dementia syndrome. Psychological approaches offer an alternative way of care, which remains to be investigated and validated. Prevention of iatrogenic effects of drugs constitutes, presently, the main therapeutic intervention.

[Ethical approach to severe dementia]. / Pour une approche éthique dans la démence sévère.

General principles of medical ethics are discussed in the context of care for patients with severe dementia.